Correct!

Although, you may need to eventually refer to a specialist, it is very appropriate that you further investigate the lesions to confirm or better characterize your diagnosis.

Investigating Neck Masses

Based on your patient, you order a CT of the head and neck with IV contrast to better characterize the lesions and to locate the primary and other sites of metastasis. You also order a Fine Needle Aspiration Biopsy of the neck mass to confirm your diagnosis. Finally, you also obtain a biopsy of the oral lesion (in reality, you will obtain the biopsy while conducting the physical exam).

Note: If you are uncomfortable performing any of these procedures, you may refer to a specialist to do so.

To investigate metastasis to other sites of the body:

H&N Cancer Metastasis: lung > liver > bone

Therefore, PA and lateral Chest X-ray and blood tests for liver enzymes (alkaline phosphatase, liver function test) may be done. Bone scans are not indicated in the initial workup of metastasis.

What is the most likely pathological diagnosis:

• Small Cell Carcinoma
• Squamous Cell Carcinoma
• Mucoepidermoid carcinoma
• Schneiderian papilloma